Suicide prevention, intervention, postvention · SUICIDE PREVENTION, INTERVENTION, POSTVENTION y...

SUICIDE PREVENTION,INTERVENTION,POSTVENTION

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Suicide is the 10th leading cause of

death in the U.S….

2015 statistics


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Each year 44,193 Americans die by

suicide…

2015 statistics


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On average there are 121 suicides

every day…

2015 statistics


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Firearms as a method account for

almost 50% of all suicides…

2015 statistics


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White males accounted for 7 of 10

suicides in 2015…

2015 statistics


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2017

Over 1 million people die by suicide,

worldwide, each year…

2015 statistics


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75% of global suicide occurred in low-

and middle-income countries in 2012.

SUICIDE PREVENTION,

INTERVENTION,POSTVENTIONA

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3 areas of safety from suicide

■ Prevention

■ Intervention

■ Postvention

Poll Question

■ Have you ever known someone who died by suicide,

or who attempted suicide?

– ATTEMPTED but lived

– DIED by suicide

– NONE of the above

What is suicide?

■ Selfish

■ Weak

■ Good life

■ Attention

■ Message

Activity: Life Stressors

■ Think of a typical life stressor

■ Money

■ Relatives/Family

■ Job

■ Divorce


■ Relationship problems

■ Money

■ Job Stress

■ Kids

■ Moving

■ Job Loss

■ Death of a loved one

■ Other stressors


■ Keep carrying the books?

■ Put them away properly, one by one?

■ When heavy enough, for a long

period of time.. The inclination is to

just DROP all the books.

What is suicide?

■ Want pain to end

■ See no solutions

■ See no hope

Reasons for Suicide

■ Pain ■ Loss

Who dies by suicide?

■ Adults between 45-64 years of age

■ Adults 85 years of age and older

2015 statistics

■ Youth ages 15-24 have the lowest rate of suicide deaths.

Reasons for Suicide

■ Pain ■ Loss

■ Adults 85 years of age and older

Not going to improve Not going to improve

Prevention vs. Intervention

■ Prevention:

– Prevention of the elements that lead to thoughts of suicide

– Teaching the tools for coping

– Recognizing signs of self-destruction

Prevention vs. Intervention

■ Intervention:

– Recognizing the signs of suicidal ideation and stepping in to

prevent follow-through

– Assisting someone in finding resources to help them deal with

or resolve whatever is causing their suicidal thoughts

– Implementing a safe plan with the individual

Postvention

■ Prevention of a new cycle

– Care offered to friends & family left behind after a suicide

– Watching for same signs as the Prevention phase

– Those left behind are at risk

RESPONDING TO SIGNS OF SUICIDE

Would you know what to do?...

Imagine…

This is for my mom, my dad and “brother.” This is my last words. I hope you are not grieving of my death. I am

sorry for my pain I have put upon you. Mom I love you. I am sorry.”

Poll Question

■ Do you feel confident that you would know what to do to save this child’s life or help him stop thinking of suicide as a solution?

– YES

– NO

PREVENTIONBefore thoughts of suicide begin

“She seemed fine.”

Prevention ■ Talking about suicide

– Any mention of suicide,

even when making jokes

– Asking questions about

suicide

– Talking about other

suicides

Look for warning signs

Prevention ■ Untreated depression

– Crying spells

– Difficulty getting out of bed

– Problems sleeping

– Bad eating patterns

– Feeling hopeless

– State of pain makes them

shut down

– Thinking clouded

– Life feels pointless


Prevention ■ Giving away possessions

– Things valued by them

– “Don’t need it anymore”

– Taking care of loose ends

– Turning over responsibility

(pet care, etc.)


Prevention ■ Saying goodbye

– Visiting family & friends

– Letters expressing feelings

– Closure

– Could be phone/text


Prevention ■ Suicide notes

– If written/found prior to

death, take seriously

– Attempt to explain pain

– Make sure people know

they cared

– Take care of loose ends


Prevention ■ Alcohol & drugs

– Increase/abuse

– Make problems worse

– Helps to build courage


Prevention ■ Sudden calmness

– Change to calm or happy

– Comes from decision reliefLook for warning signs

Prevention ■ Reckless behavior

– Behavior & decisions

– Trying new things – drugs,

extreme sports

– Reckless driving


Prevention ■ Researching suicide

methods

– Internet browser history

– Painless suicide / how-to

– Asking questions


Prevention ■ Buying suicide materials

– Gun shopping

– Rope

– Pills

– Knives, Razors

Having the means is

dangerous and should be

taken seriously


Prevention ■ Creating a will

– Creating a will

– Last-minute will revisions

– Questions re: life insurance


Prevention ■ Social withdrawal or

isolation

– Isolate from friends, family,

colleagues

– Causes more depression

– Withdrawal from social

commitments and

extracurricular activities


Prevention ■ Talking about being a

burden

– Apologizing frequently

– Feelings of causing

unwanted problems

– Talk of being a burden


Prevention ■ Feeling hopeless

– Talk about being hopeless

– Talk of hopeless situation

– Feeling helpless or

worthless


Prevention ■ Preoccupation with death

– Openly talking of death

– Researching death

– Talking about afterlife


Prevention ■ Previous suicide attempt

– Increased risk of attempt

– 20-50% who die by suicide

had a previous attempt

– Previous attempt makes

suicide more comfortable

to them. Not an unknown.


Actions to watch for

ACTIONS• Giving away possessions

• Withdrawal (family, friends, school, work)

• Loss of interest in hobbies

• Abuse of alcohol, drugs

• Reckless behavior

• Extreme behavior changes

• Impulsivity

• Self-mutilation

Thoughts to listen for

THOUGHTS

"All of my problems will end soon"

"No one can do anything to help me now"

"Now I know what they were going through"

"I just can't take it any more"

"I wish I were dead"

"Everyone will be better off without me"

"I won't be needing these things anymore"

"I can't do anything right"

"I just can't keep my thoughts straight

anymore"

Feelings to watch for

FEELINGS

• Desperate

• Angry

• Guilty

• Worthless

• Lonely

• Sad

• Hopeless

• Helpless

Physical signs to watch for

PHYSICAL

• Lack of interest in appearance

• Change/loss in sex interest

• Disturbed sleep

• Change/loss of appetite, weight

• Physical health complaints

What to do

■ Ask / listen to what the problems and stressors are

■ Help find resources

– Counseling

– Job search

– Family assistance

– Support network / friends

■ 800-273-8255 (National Suicide Prevention Lifeline)

INTERVENTIONSaving the life of someone contemplating suicide

“I just need to know there’s hope.”

People hide what they don’t want you to know or see.

Intervention allows someone to talk about their suicidal thoughts without judgment.





What is an intervention?

Definition:

Interference so as to modify a

process or situation

What is an intervention?

Thoughts of Suicide

Suicidal Behavior

Death or Harm

“Contributaries” of Suicide

(no thoughts of suicide)

Credit: Applied Suicide Intervention Skills Training (ASIST)

How does aninterventionwork?


Understanding

Connecting Assisting

Phase 1:Connecting


Connecting

Phase 1:Connecting


ConnectingFriend: “I’m just going to end all of

this and fix all my problems.”

You: “ .”

Phase 1:Connecting


ConnectingAccept what the person is

saying, without judgment, and

let them know you’re here to

help.

Phase 1:Connecting


Connecting“I can see you really seem to

be having a hard time.”

“Tell me what’s bothering you

the most.”

“That does sound very

difficult.”

“What else?” “Tell me more.”

Phase 1:Connecting


ConnectingIt’s not about you, or your

opinions.

Build trust.

Create a sense of trust and

openness for sharing.

Goal: Save the person’s life.

Phase 1:Connecting


Listen for red flags / risk factors

1st question: Are you having

thoughts of suicide?

?■ Review Risk

■ ARE YOU HAVING THOUGHTS OF SUICIDE?……suicide

RISK

ALERT

Phase 1:Connecting


Ask questions about current

factors that may contribute to

their suicidal thoughts.

“Do you have a plan?”

?■ Review Risk


RISK

ALERT

CURRENT FACTORS

preparedCurrent Suicide Plan

How? How prepared? How soon?…………………….

desperatePain

Do you have pain that at times feels unbearable?…..

aloneResources

Do you feel you have few, if any, resources?………...

“Do you have pain that at

times feels unbearable?”

“Do you feel you have few, if

any, resources?”

Phase 1:Connecting


Ask questions about background

factors that may contribute to

their suicidal thoughts.

“Have you ever attempted

suicide before?”

?■ Review Risk


RISK

ALERT

CURRENT FACTORS



desperatePain


aloneResources


BACKGROUND FACTORS

vulnerable

+ Mental Health

Are you receiving or have you receivedmental health care?………………………………………

familiar

+ Prior Suicidal Behavior

Have you ever attempted suicide before?…………….

“Are you receiving or have you

received mental health care?”

Poll Question

■ When it comes to being a good listener, how would

you rate yourself?

– I’m an EXCELLENT listener

– I’m a PRETTY GOOD listener

– I’m an “OK” listener

– I’m a TERRIBLE listener

Phase 2:Understanding


Understanding

Ask them to tell you all about all

of the stressors.

Listen without judgment or

opinion, and without trying to

turn them to more positive

thinking.



Understanding

Connecting





Understanding

Listen for cues about reasons for

living.

Listen for ambivalence.


“Survivors often regret their

decision in midair, if not before.”

“I instantly realized that

everything in my life that I’d

thought was unfixable was totally

fixable – except for having just

jumped.”

Who can die by suicide?

How can THIS person be

thinking of suicide?

Anyone is at risk.

What is a stressor?

Remember: What is

stressful to one person

may not be to another.

And what you consider

stressful may not be to

someone else, and vice

versa.

Caregiver attitudes matter

The caregiver is the only one who has

clarity and focus. Those thinking of

suicide can only focus on the things

that are causing them to feel

hopeless.

Phase 3:Assisting


Assisting

Ph

ase

3: A

ssis

tin

g


?■ Review Risk


RISK

ALERT

CURRENT FACTORS

BACKGROUND FACTORS



desperatePain


aloneResources


vulnerable

+ Mental Health


familiar



Contract Safeplan

• Safety contact(s)

• Keep safe

• Safe/no use of alcohol/drugs

• Link to resources

ALL SAFEPLANS

Ph

ase

3: A

ssis

tin

g


?■ Review Risk


RISK

ALERT

CURRENT FACTORS

BACKGROUND FACTORS



desperatePain


aloneResources


vulnerable

+ Mental Health


familiar



• Link to health worker

• Protect against the danger/

support past survival skills

• Disable the suicide plan

• Ease the pain


RISK SPECIFIC SAFEPLANS

Contract Safeplan

• Safety contact(s)

• Keep safe

• Safe/no use of alcohol/drugs


ALL SAFEPLANS


family & friends

advisershealth

workers

emergency

personal connections

community

24-hour

Longer-term

Life-long

Informal Resources Formal Resources

800-

273-

8255

Phase 3:Assisting


Phase 3:Assisting

EXPLORE invitations recognition valuedanswer honestly about thoughts of suicide

ASK about suicide permission relievedtalk openly about suicide

LISTEN to reasons for dying and living

perspective acceptedmove toward their life side

REVIEW risk care respectedhelp develop their safeplan

CONTRACT a safeplan hope encouragedcommit to their safeplan

FOLLOW-UP on commitments

safety supported keep safe

When caregivers…

they meet the person at risk’s need for…

The person at risk feels…

and is more likely to…

CONNECTED

UNDERSTOOD

ASSISTED



Connectinginvitations?

suicide?

explore

ask

Understanding

reasons?

risk?

listen

review Assistingsafeplan?

commitments?

contract

follow-up



Goals of an intervention


PAST PRESENT FUTURETime

ALONE ENGAGED LINKEDRelationship

DEATH AMBIVALENCE LIFEExistence

Connecting Understanding Assisting

Patiently listen TO the death side of

ambivalence; help the person at risk

talk about their reasons for dying

Persistently listen FOR the life side

of ambivalence; search for reasons

for living or reinforce them when the

person at risk discovers them

DEATH LIFE


Poll Question

■ At this point, how confident do you now feel that you

could recognize someone who is having thoughts of

suicide, and help them to live?

– MUCH MORE CONFIDENT

– JUST AS CONFIDENT

– STILL NOT CONFIDENT

POSTVENTIONHelping someone who’s lost someone to suicide

I don’t understand, and I’m hurting.

Responding to a suicide

■ Family just lost a loved one

■ Cause of death is irrelevant

■ They are shocked, traumatized, confused, grieving, and have questions

Questions of the survivors

■ Does suicide run in the family?

■ Suicide is a learned behavior.

– Families pass on behavior and emotional environments

– Families can teach poor coping skills, self-destructive behavior

– Depression and anxiety are contributors

Life Stressors

■ Relationship problems

■ Money

■ Job Stress

■ Kids

■ Moving

■ Job Loss

■ Death of a loved one

■ Other stressors

Postvention = Prevention

■ Listen for signs of wanting to die

■ Start the Connecting Phase with the family members

■ Assess the level of risk, and ask about factors that may contribute to

future thoughts of suicide

Resources

■ Offer resources for the family members

■ 1-800-273-8255 (TALK)

– (National Suicide Prevention Lifeline)

■ 9-1-1

■ Emergency room

■ Physician

■ Family members

■ Friends

■ Clergy

■ Counselor

Expectations

■ Talk about what they can expect

■ A significant loss

■ A traumatic event

■ May need to seek help later

■ Ask them to think about who they might call at the time.

Resources

■ Who are your resources?

■ Think to yourself of who you would call. Do you have

their number ready?

THANK YOU!Amy Morgan, MSC

Academy Houremail: [email protected]

Phone: 405-326-4116

www.AcademyHour.com

mailto:[email protected]

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Suicide prevention, intervention, postvention · SUICIDE PREVENTION, INTERVENTION, POSTVENTION y...

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